A Nationwide Survey on the Facilities and Personnel for Endoscopic Sedation: Results from 50 Qualified Endoscopy Units of Teaching Hospitals Accredited by the Korean Society of Gastrointestinal Endoscopy (KSGE)

Background/Aims@#This study aimed to determine the current status of facilities, equipment, and personnel for endoscopic sedation from endoscopy units of representative hospitals in South Korea. @*Methods@#A questionnaire survey was conducted on 50 qualified endoscopy units accredited by the Korean Society of Gastrointestinal Endoscopy. @*Results@#All included endoscopy units had regulations and educational programs regarding sedation training for endoscopists and nursing personnel. There present one assisting nurse during endoscopy in 35 units (70%) and at least two nurses in 12 units (24.0%). All endoscopy units had examination rooms equipped with oxygen supply and suction systems. Endoscopist-directed sedation was performed in 48 units (96.0%). Propofol-based sedation was the most used sedation method. All units had a separate recovery bay. The daily number of patients per bed was greater than 10 in 17 units (34.0%). In 26 (52.0%) units, a single nurse cared for ≥10 patients per day. All the units fulfilled the discharge criteria. @*Conclusions@#This study presents data regarding endoscopic sedation clinical practice in 50 endoscopy units in South Korea. This study presents the current status of endoscopic sedation clinical practice in 50 qualified endoscopy units accredited by the KSGE, which provide excellent quality management.

Short-term Clinical Outcomes of Scleral Fixation of Intraocular Lenses Using a Scleral Tunnel and Groove

PURPOSE: We evaluated the short-term clinical outcomes of patients who underwent modified scleral fixation of an intraocular lens (IOL) using a scleral tunnel and groove. METHODS: From June 2016 to May 2017, 34 eyes of 34 patients who underwent modified scleral fixation of an IOL using a scleral tunnel and groove were retrospectively studied. We evaluated the best-corrected visual acuity (BCVA), corneal endothelial cell density, intraocular pressure (IOP), spherical equivalent, and postoperative complications at 1 week, 1 month, 3 months, and 6 months after surgery. RESULTS: The BCVA was 0.85 ± 0.83 logarithm of the minimal angle of resolution (logMAR) before surgery and 0.38 ± 0.61 logMAR at 6 months (p = 0.001). The corneal endothelial cell count was 1,955.12 ± 217/mm2 and 1,852.59 ± 190/mm2, before and after surgery, respectively, which was not significantly different (p = 0.186). Postoperative complications occurred in eight eyes (23.5%); IOP elevation in one eye (2.9%), IOL tilt or decentration in two eyes (5.7%), optic capture in four eyes (11.4%), and cystic macular edema in one eye (2.9%). The spherical equivalent showed myopic changes after surgery and decreased significantly over time (p = 0.001). CONCLUSIONS: Modified scleral fixation of the IOL using a scleral tunnel and groove improved the BCVA, but did not significantly affect corneal endothelial cell loss. This procedure can be a good alternative to conventional scleral fixation of an IOL, which has advantages in shortened surgical time and easy surgical manipulation.

Association of the GSTM1 and GSTT1 Genes with Diabetic Retinopathy in the Korean Population

PURPOSE: To investigate the correlation between Glutathione-S-transferase (GST) genes and diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (DM). METHODS: In this case-control study, 131 patients who were diagnosed with DR, 105 diabetic patients who did not have DR, and 45 nondiabetic controls were examined from January 2013 to November 2015. To analyze deletion of the GSTT1 and GSTM1 genes, polymerase chain reactions of DNA in a buffy coat from peripheral blood were performed via electrophoresis. RESULTS: There were no statistically significant differences in age, sex, or spherical equivalent between the 236 type 2 diabetic patients and the 45 normal controls (p > 0.05). In both univariate and multivariate analyses, the duration of type 2 DR was longer (p = 0.004, p = 0.013), and HbA1c was higher (p = 0.004, p = 0.007) in the DR group than in the non-DR group. Presence of a GSTM1 deletion is associated with a lower frequency of DR (p = 0.017, p = 0.012). CONCLUSIONS: Deletion of the GSTT1 gene is not associated with an increased risk of DR, whereas GSTM1 deletion is associated with a lower risk of DR in patients with type 2 DM in the Korean population. Additional studies with larger sample sizes and different types of GST genes are needed to confirm this study.

Management of Anterior Chamber Migration of Dexamethasone Intravitreal Implant

No abstract available.

Changes of Higher-Order Aberrations after Microcoaxial Cataract Surgery According to Pupil Size

PURPOSE: To analyze changes of higher-order aberrations (HOAs) after micro-coaxial cataract surgery according to pupil size and to evaluate systemic factors affecting these changes. METHODS: Forty-two patients (42 eyes) who had undergone micro-coaxial cataract surgery were followed-up in the present study. HOAs (total RMS, coma, trefoil and spherical aberration) were measured at 1 week, 1 month, 3 months and 6 months post surgery. Differences of HOAs according to pupil size and systemic factors affecting changes of HOAs were analyzed. RESULTS: Total RMS (1.08 +/- 0.89 microm) and spherical aberration (0.03 +/- 0.13 microm) were lower in the group with a pupil size between 5.6 and 6.4 mm at 1 month after surgery compared with the group with pupil size lower than 5.5 mm (1.69 +/- 0.97 microm, 0.09 +/- 0.11 microm) or the group with pupil size larger than 6.5 mm (1.75 +/- 0.87 microm, 0.12 +/- 0.18 microm), which remained low at 6 months after surgery. Coma and trefoil showed a similar tendency. Patients with diabetes mellitus had smaller pupil size and higher total RMS, coma, trefoil and spherical aberration values at 1 month after surgery compared with patients without diabetes. CONCLUSIONS: HOAs were lowest in patients with pupil size between 5.6 and 6.4 mm after micro-coaxial cataract surgery. Patients with diabetes mellitus tend to have smaller pupil size after micro-coaxial cataract surgery and show higher postoperative HOAs.

Long-Term Results after Three or More Penetrating Keratoplasties and Risk Factors for Graft Failure

PURPOSE: To evaluate the primary indications, surgical outcomes, causes and risk factors for graft failure in patients with three or more penetrating keratoplasty (PKP) surgeries. METHODS: We retrospectively analyzed indications for the initial corneal graft, survival periods, causes and risk factors for failure in 25 patients (26 eyes) who had undergone three or more PKP with minimum follow-up periods of nine months. RESULTS: The most common primary indications were herpes simplex keratitis (26.9%), followed by fungal keratitis (19.2%) and bacterial keratitis (11.5%). The average survival period of graft in three or more PKP was 12.9 +/- 9.1 months. As the frequency of PKP increased, the survival period became shorter; the survival period was the longest in pseudophakic bullous keratopathy and the shortest in herpes simplex keratitis. The most common cause of graft failure was allograft rejection (82.8%), and the risk factors for graft failure were short interval between penetrating keratoplasties and corneal neovascularization. CONCLUSIONS: In three or more PKP, as the frequency of PKP increases, the survival period becomes shorter. Short interval between keratoplasties and cornel neovascularization were risk factors for graft failure; this results must be considered before surgery.

Microcystic Adnexal Carcinoma Treated by Mohs' Micrographic Surgery / 대한피부과학회지

Microcystic adnexal carcinoma (MAC) is an uncommon skin appendage neoplasm with both follicular and sweat duct differentiation. It usually extends microscopically far beyond assessed clinical margins and spreads locally in the dermal, subcutaneous fat, muscle, and perineural tissue planes. Although its metastasis is very rare, local recurrence rate after standard excision is 40~59%. Recently, Mohs micrographic surgery (MMS) was introduced for the treatment of MAC and a more favorable cure rate has been reported. We report a case of MAC, which was treated by MMS, which concurred with thymoma and thyroid papillary carcinoma in a 50-year-old woman.

A Case of Disseminated Superficial Porokeratosis with Dermal Amyloid Deposition / 대한피부과학회지

Secondary localized cutaneous amyloidosis appears in association with a variety of inflammatory skin diseases and skin tumors. The presence of dermal amyloid deposits in lesions of porokeratosis has rarely been described in the literature. We describe a Korean case of disseminated superficial porokeratosis, with clear histologic evidence of amyloid deposition in the upper dermis.